Tough controls over cosmetic surgery are to be announced today by the government as two reports reveal the pitfalls of the nation's growing willingness to go under the knife in search of beauty.
There has been increasing concern over the heavily advertised clinics where surgeons carry out nose re-shaping, liposuction, tummy tucks and face lifts.
Some surgeons are under-qualified - perhaps with expertise, but not in the relevant part of the body. An ear, nose and throat specialist might be carrying out a breast enlargement, for instance.
Some clinics promote their services heavily and fail to give enough information to the client about what they can expect from the operation.
But one of the reports commissioned by the government, written by the Healthcare Commission and published today, will say that there is also cause for concern about the more minor procedures that are becoming increasingly popular, such as Botox injections.
Sir Liam Donaldson, the chief medical officer, will announce new controls against the background of this report and a second by the expert group on the regulation of cosmetic surgery, chaired by the patient tsar, Harry Cayton. It is understood that they have put forward 17 recommendations.
The government is expected to accept proposals to ban doctors from carrying out cosmetic surgery unless they have at least five years training in a relevant speciality.
It will also accept the need for a code of practice specifying the information which must be provided to patients before they consent to undergoing surgery and guidelines on advertising by firms and doctors specialising in this type of treatment.
The Healthcare Commission estimates there are at least 600 surgeons working in the field, but fewer than 300 have the relevant specialist qualifications.
The commission is also concerned about the minor procedures such as Botox injections to get rid of wrinkles, chemical peels and injectable fillers, which are totally unregulated and offered by many small clinics.
"Cosmetic and aesthetic procedures to improve appearance are far more accessible and affordable than in the past. These procedures, if properly conducted, are safe, but there are risks," said Simon Gillespie, the Healthcare Commission's head of operations.
"The safety and quality of cosmetic and aesthetic procedures in England needs to be kept under regular review, not least to understand and respond to new developments.
"The Healthcare Commission will be carrying out further work to develop minimum standards of practice to ensure the safety of patients."
The commission believes that there needs to be further assessment of the procedures offered by clinics, to decide whether any of them in fact pose risks to the patient and need regulation.
Britons spend more than £200m a year on cosmetic surgery, but the signs are that we are not always made happy by it - the industry pays out more than £1m a year in compensation to dissatisfied customers.
The Medical Defence Union said yesterday that complaints had been steadily rising over the last 10 years, although the number of claims settled was small.
"In our experience, the commonest reason for patients who have undergone plastic surgery to bring a claim is that they are dissatisfied with the results of the procedure.
"They had thought the surgery would enhance their looks and were disappointed with the results. Only a small number of claims arise from poor surgical technique," said Stephen Green, the MDU's head of risk management.
"Patients may have unrealistic expectations of what can be achieved by cosmetic surgery so it is important for surgeons to counsel patients about the likely outcome, possible risks and complications in advance."
